Computerized medical training system

ABSTRACT

A method of medical training includes presenting a user with a medical scenario within a medical simulation in which the user plays a physician. The medical scenario includes an interaction between the user and a patient. Performance data corresponding to the user is identified. The identified performance data is based at least in part on an action of the user during the interaction between the user and the patient. The user is evaluated based at least in part on the identified performance data to determine whether the user has achieved a training goal within the medical simulation. The training goal is intended to improve a medical skill of the user.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority from U.S. Provisional Application No.60/830,183, filed Jul. 12, 2006, and incorporated herein by reference inits entirety.

FIELD

The subject of the disclosure relates generally to medical training.More specifically, the disclosure relates to a method, system, andcomputer-readable medium for teaching empathy, patient-centeredness,professionalism, interviewing micro-skills, and communication skills(e.g., bedside manner) through constructivist learning in a social,three-dimensional environment with emotionally expressive avatars.

BACKGROUND

During medical school, medical students learn human anatomy, diseasesymptoms, disease stages, diagnostic techniques, treatment techniques,and other scientific information needed to think critically about thediagnosis and treatment of illnesses. However, being a good physicianrequires more than just scientific knowledge. A physician also needs tobe able to form and maintain effective relationships with his/herpatients. This can be challenging because each patient is a uniqueindividual that can differ from other patients in appearance,background, experience, educational level, cognitive ability, religion,attitude, ethnicity, etc. To form effective relationships with such awide array of patients, the physician must be patient, perceptive,understanding, supportive, and empathic. In addition, the physicianneeds to be able to portray his/herself as a knowledgeable andtrustworthy individual.

Present-day medical curriculums focus on conveying scientific knowledgeand do not adequately train physicians in patient interactions. Thislack of curricular emphasis on medical humanism and the lack of properintegration of sociological and psychological information into medicaltraining results in physicians who do not have the necessary tools tounderstand patients as people, to effectively convey information topatients, or to effectively listen to patients. Even in medical schoolsin which an effort to teach medical humanism is made, the effort islargely ineffective. Books and lectures do not even begin to exposemedical students to the wide array of situations in which physiciansfind themselves during their day-to-day practice. Further, books andlectures do not provide medical students with any experience ininteracting with patients, colleagues, medical staff, pharmacists,superiors, insurance company representatives, or other individualsinvolved in the medical profession. Books and lectures are furtherlimited in their ability to help medical students understand why certaininformation is critical to acquire, and what the consequences are ifthat information is ignored.

As a result of the above-mentioned curricular deficiency, the majorityof physicians are unable to effectively communicate with or otherwiserelate to their patients. Poor physician/patient relationships can leadto misdiagnosis and/or other medical errors. Medical errors result inapproximately 200,000 patient deaths each year, more than the number ofindividuals who die from motor vehicle accidents, breast cancer, andAIDS combined. Medical errors are also the primary basis for medicalmalpractice claims brought against physicians. In addition, poorphysician/patient communication can lead to uninformed patients,misinformed patients, unhappy patients, patients who are unable orunwilling to adhere to a prescribed treatment, and/or patients whoreject the medical profession.

Another problem in the medical profession is that most physicians enterpractice with no concept of medical economies, medical policies, goodbusiness practices, or good management practices. This again stems froman inability to effectively teach these skills in a traditional medicalschool classroom. Yet another problem in the medical profession is thelack of consistency in medical practices across professionalcommunities. Medical practices are inconsistent from region to region,from state to state, from medical school to medical school, and evenamong different faculty at the same medical school. Inconsistent medicalpractices can make it difficult for physicians to transfer locationsand/or work with physicians in other geographic regions. Inconsistenciescan also make a difficult and sometimes frustrating profession even morefrustrating for new medical school graduates. In addition, it can beespecially difficult for medical students because inconsistencies existnot only between regions and individuals, but also between the attitudesand practices that medical students observe and the values that areexplicitly taught to them. This so-called ‘hidden curriculum’ (i.e., thesocial and cultural aspects of education that exist alongside aneducational institution's stated or intended curricular objectives)creates a huge problem for medical students as they try to develop anethical and reflective style of practice.

Thus, there is a need for a medical training system capable of teachingmedical personnel how to effectively interact with patients throughactual experience. There is also a need for a medical training systemcapable of teaching medical personnel how to effectively interact withother physicians, assistants, staff, billing coordinators, and any otherpersonnel associated with the medical profession. There is also a needfor a medical training system capable of effectively teaching medicalpersonnel about medical economics, medical policy, good businesspractices, and good management practices. Further, there is a need for amedical training system capable of consistently training a large numberof medical personnel such that medical practices are able to become moreconsistent throughout the medical profession and conform more closely tothe humanistic, patient-centered values that are espoused.

SUMMARY

An exemplary method of medical training includes presenting a user witha medical scenario within a medical simulation in which the user plays aphysician. The medical scenario includes an interaction between the userand a patient. Performance data corresponding to the user is identified.The identified performance data is based at least in part on an actionof the user during the interaction between the user and the patient. Theuser is evaluated based at least in part on the identified performancedata to determine whether the user has achieved a training goal withinthe medical simulation. The training goal is intended to improve amedical skill of the user.

An exemplary computer-readable medium has computer-readable instructionsstored thereon that, upon execution by a processor, cause the processorto maintain a medical simulation. The instructions are configured topresent a user with a medical scenario in which the user plays aphysician. The medical scenario comprises an interaction between theuser and a patient. Performance data corresponding to the user isidentified. The identified performance data is based at least in part onan action of the user during the interaction between the user and thepatient. The instructions are further configured to determine, based atleast in part on the identified performance data, whether the user hasachieved a training goal within the medical simulation. The traininggoal is intended to improve a medical skill of the user.

An exemplary system for medical training includes a medical trainingengine, a memory, and a processor. The medical training engine includescomputer code configured to generate a medical scenario within a medicalsimulation. The medical scenario is presented to a user, where the userplays a physician within the medical scenario. Performance data based onan action of the user within the medical scenario is identified. Thecomputer code is further configured to determine, based at least in parton the identified performance data, whether the user has achieved atraining goal within the medical simulation. The training goal isintended to improve a medical skill of the user. A status of the user isincreased within the medical simulation if the user has achieved thetraining goal. The memory is configured to store the medical trainingengine. The processor is coupled to the memory and configured to executethe medical training engine.

Other principal features and advantages will become apparent to thoseskilled in the art upon review of the following drawings, the detaileddescription, and the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments will hereafter be described with reference to theaccompanying drawings.

FIG. 1 is a flow diagram illustrating operations performed by a medicaltraining system in accordance with an exemplary embodiment.

FIG. 2 is a medical training system in accordance with an exemplaryembodiment.

FIG. 3 is a diagram illustrating components of a medical training systemin accordance with an exemplary embodiment.

FIG. 4 is a diagram illustrating a physician office in accordance withan exemplary embodiment.

FIG. 5 is a diagram illustrating a reception area in accordance with anexemplary embodiment.

FIG. 6 is a diagram illustrating a corridor within the medical facilityin accordance with an exemplary embodiment.

FIG. 7 is a diagram illustrating an exam room in accordance with anexemplary embodiment.

FIG. 8 is a diagram illustrating a virtual conference room in accordancewith an exemplary embodiment.

DETAILED DESCRIPTION

Described herein is a training system adapted to teach users how tosuccessfully interact with other individuals. In an exemplaryembodiment, the training system (or system) can be an on-line simulationin which users can interact with one another and participate inscenarios. The system can also refer to any of the hardware and/orsoftware which is used to implement the simulation. The system can beimplemented by any programming method known to those of skill in theart. In an exemplary embodiment, the on-line simulation can utilizemassively multi-player on-line gaming (MMOG) structures, procedures, andmethodologies. As such, the simulation can take place in a distributed,three-dimensional synthetic environment. The synthetic environment,which may include game play design elements, can also include avatars.As used herein, an avatar can refer to a simulated character controlledby a live user or a computer controlled (i.e., virtual) character withinthe simulation. Avatars controlled by the computer can feature cognitiveand emotional modeling such that their behavior is highly realistic andhuman-like. The synthetic environment, which may include game playdesign elements, can also include realistic avatars that featurecognitive and emotional modeling. As used herein, an avatar can refer toa simulated character controlled by a live user or a computer controlled(i.e., virtual) character within the simulation. These features cancombine to create a naturalistic, highly social, and constructivistlearning environment in which users can experientially learn values,empathy, patient and/or client-centeredness, professionalism,interviewing micro-skills, communication skills, etc. The simulation canalso utilize virtual reality technology to further enhance the realismand impression of the simulation.

As described herein, the system can be used to teach medical studentshow to interact and form relationships with patients and/or any otherindividuals whom they may encounter in their role as physicians. Thesystem can also be used by practicing physicians to obtain continuingmedical education credits, by medical school professors to interact withand test their students, by medical staff for training purposes, bypatients who want to form better relationships with their physicians,and/or by the general public as a diversion. While the training systemis primarily described with reference to training in the medical field,it is important to understand that the system is not so limited. Usingthe same principles described herein, the training system can be appliedto any field/profession in which individuals are required to interactand form relationships with other individuals. For example, the trainingsystem can be used in the legal field to teach law students andattorneys how to effectively interact with their clients. Similarly, thetraining system can be used to teach nurses, dentists, businessmanagers, coaches, teachers, receptionists, customer servicespecialists, bankers, etc. how to interact with and treat their clients,students, and/or employees.

FIG. 1 is a flow diagram illustrating operations performed by a medicaltraining system in accordance with an exemplary embodiment. Additional,fewer, or different operations may be performed in alternativeembodiments. In an operation 100, the medical training system canreceive registration information from a user. The registrationinformation can include the user's name, contact information,profession, level of training, etc. The registration information can bereceived by any method known to those of skill in the art. In oneembodiment, the system can also receive a monetary fee from the userduring registration. The monetary fee can be paid directly by the user,by the medical school which the user attends, by the user's employer, orby any other entity. In an exemplary embodiment, the user can be amedical student, and the registration process can be performed when themedical student registers for a class which utilizes the medicaltraining system as an instructional tool.

In an operation 105, the system provides the user with access to amedical simulation. The medical simulation can be a virtual worldincluding one or more medical settings in which physicians can interactwith patients and other individuals. The medical settings can be anylocations, such as a clinic, a hospital, a patient's home, a nursinghome, a hospice facility, etc., in which a medical practitioner may becalled upon to practice medicine. The medical simulation can alsoinclude homes, stores, vehicles, banks, governments, etc. in both urbanand rustic settings to make the medical simulation more realistic.Access to the medical simulation can be provided through medicalsimulation software which the user downloads and installs on his/hercomputer. Alternatively, access can be provided through a website uponwhich the medical simulation can be accessed. Alternatively, access tothe medical simulation can be provided by any other method known tothose of skill in the art. In one embodiment, different versions of themedical simulation can be used to accommodate different types of users.A first version can be for medical student users, a second version canbe for practicing physician users, and a third version can be for thegeneral public. Alternatively, a single version can be used toaccommodate all system users.

In an exemplary embodiment, the medical simulation can be an on-lineworld which is accessible through a network such as the Internet. Assuch, multiple users can interact with and learn from one another. FIG.2 is a medical training system 200 in accordance with an exemplaryembodiment. Medical training system 200 includes a medical trainingserver 205 connected to a network 210. Medical training server 205 canbe a computer including a memory, a processor, and input/output ports.As such, medical training server 205 can be capable of maintaining oneor more medical simulations, receiving data from users within the one ormore medical simulations, sending data to users within the one or moremedical simulations, and/or storing data corresponding to the usersand/or the one or more medical simulations. Network 210 can be anynetwork upon which information can be transmitted as known to those ofskill in the art. A first user device 215, a second user device 220, anda third user device 225 can be in communication with medical trainingserver 205 through network 210. First user device 215 can be a desktopcomputer of a first user, and second user device 220 can be a laptopcomputer of a second user. Third user device 225 can be a cellulartelephone, personal digital assistant, or any other electronic device ofa third user which is capable of communicating with medical trainingserver 205 through network 210. In an alternative embodiment, the systemmay communicate with users through peer-to-peer networking, and medicaltraining server 205 may not be used.

Referring back to FIG. 1, in an operation 108, the system receivespersonal information regarding the user. The personal information can beany information which can be used to evaluate the user's medicalexperience, medical skills, strengths, weaknesses, and/or computingexperience. The personal information can be used to help design anavatar for the user, to determine appropriate training goals for theuser within the medical simulation, and/or to determine appropriatemedical scenarios in which the user should participate. As an example,the user can indicate that his/her biggest fear is conveying bad news,such as telling the patient that he/she has a chronic illness, thathis/her therapy has failed, that he/she is going to die, etc. To helpthe user overcome this fear, the user can be placed in medical scenarioswith patients who need to be told that they suffer from a chronicillness. The personal information can also include psychometric data ofthe user. The psychometric data may be used to condition interactions ofthe user within the medical simulation.

In an exemplary embodiment, the personal information can be receiveddirectly from the user. Alternatively, the personal information can bereceived from the user's professor, colleagues, patients, etc. In analternative embodiment, the personal information can be obtained duringthe registration process described with reference to operation 100. Inanother alternative embodiment, the personal information can be receivedas part of a medical simulation tutorial presented to the user.Alternatively, the medical simulation tutorial may be presented to theuser only if the user indicates that he/she has a lack of computingexperience or lack of experience within virtual worlds.

In an operation 110, an avatar is established for the user. The avatarcan be a digital representation of the user through which he/she is ableto interact in the medical simulation with the avatars of other usersand avatars generated and controlled by the system. In one embodiment,the user can select his/her avatar such that the avatar is similar inappearance to the user. For example, if the user is a 25 year old, 5′ 4″white female with blond hair, she can select an avatar with thosecharacteristics. Alternatively, the user may be allowed to select anavatar with any other of a normal range of human characteristics. In analternative embodiment, the avatar may be assigned to the user by thesystem or a training administrator such as a medical school professor.For example, a female user may be assigned a male avatar such that thefemale user can experience how various patients respond to a malephysician and/or how various physicians respond to a male patient. Inanother alternative embodiment, the system can assign an avatar to theuser based on the received personal information regarding the user.

In an exemplary embodiment, the user can have at least one avatar foreach role that he/she is to play within the medical simulation. Forexample, the user can select (or be assigned) a physician avatar forhis/her role as a physician, and a patient avatar for his/her role as apatient. In another exemplary embodiment, the patient avatar can begenerated by the system to exhibit specific patient traits. In addition,the patient avatar may not be specific to the user such that a pluralityof users can use the same patient avatar either simultaneously or atdifferent times within the medical simulation. In an alternativeembodiment, the user can have a single avatar for all of his/her roleswithin the medical simulation.

In an exemplary embodiment, the established avatar can have a statusand/or characteristics which may change over a period of time. Forexample, a new user, such as a first year medical student who is to playthe role of a physician, can have a beginner status. As such, the firstyear medical student's avatar can exhibit characteristics typical of anovice physician. For example, the avatar can appear hesitant, unsure,or intimidated when interacting with a patient. These characteristicscan be exhibited through facial expressions of the avatar, body languageof the avatar, the dialog of the avatar, and/or the general appearanceof the avatar. Once the first year medical student has passed an exam,achieved a goal, or otherwise proved his/herself within the medicalsimulation, the status and/or characteristics of his/her avatar can beupgraded to reflect a more experienced physician. For example, as asecond year medical student, the user can have an intermediate statussuch that his/her avatar appears and/or acts more calm and professionalwithin the medical simulation. Other aspects of an avatar which maychange over time can include the avatar's clothing, the avatar's title(i.e., intern, resident, new doctor, senior doctor, etc.), the avatar'sprestige, the avatar's trustworthiness, the avatar's friendliness, etc.

In an alternative embodiment, the status and/or characteristics of theavatar can be based on actual characteristics of the user. For example,the user can be an impatient person who tends to get upset when apatient does not understand an instruction or explanation. The avatar ofthe impatient user can likewise exhibit the user's impatient behaviorthrough body language and facial expressions. While interacting withpatients within the medical simulation, the user can view his/her avatarand see first hand how the impatient behavior adversely affects thepatient relationship. In an exemplary embodiment, characteristics to beattributed to a user's avatar can be identified by the user, a medicalschool professor who teaches the user, the user's colleagues in themedical practice, feedback from actual patients of the user, etc.

In an operation 115, a goal is provided to the user. In an exemplaryembodiment, the goal can be a basis within the medical simulation bywhich the user is able to elevate the status and/or characteristics ofhis/her avatar. For example, the goal may be to have a 90% or higherpatient satisfaction rate within the medical simulation over a specifiedperiod of time. Alternatively, the goal may be to overcome an adversecharacteristic of the user such as hesitancy, impatience, arrogance,condescendence, etc. These characteristics can be operationally definedwithin the medical simulation such that they are amenable tomodification. The goal can also be to improve a patient's attitude, toconvince a patient to adopt a healthier lifestyle, to convince a patientto follow a treatment schedule, or otherwise improve a patient's health.The goal can also be to successfully manage a medical facility with agiven budget, to learn how to admit patients as a receptionist, to learnhow to deal with grieving family members of a patient, to accuratelydiagnose patients, to handle a false accusation by a patient, toapologize for a mistake, etc.

In one embodiment, users can be provided with one or more short termgoals, one or more medium term goals, and/or one or more long termgoals. For example, in the role of a physician, the user may have ashort term goal of convincing a hypertensive patient to comply withhis/her medication regimen. The user may also have a medium term goal ofobtaining a patient satisfaction rating of at least 85% for aphysician/patient interaction which occurs over a plurality of officevisits and over an extended period of time. Patient satisfaction can bedetermined based on dialog used by the physician, feedback from thepatient, and/or an evaluation from a professor or other observer of theinteraction. The patient can be a live user or a computer-generatedvirtual patient. Feedback can be obtained directly from the patientuser, generated by the system, and/or provided by one or more thirdparties who view the interaction. The user may have a long term goal ofpassing a set of standardized exams at the end of a course whichfeatures the medical training system as a learning tool.

In the role of a patient, the user may be a respected businessman who isaddicted to drugs. The patient can have a short term goal of convincinga physician to issue a drug prescription without divulging his illegaldrug use. The patient can have a medium term goal of getting referred toan out of town specialist (contrary to his insurance rules) for aseemingly simple infection. The patient can have a long term goal ofseeking treatment for what he suspects may be AIDS without divulging hisdrug use or the fact that he has shared needles with others. A patientgoal can also include convincing the physician that the patient ishealthy such that the patient is relieved from thinking about his/herillness. As such, the ‘victory’ conditions for the physician and for thepatient may conflict with one another. These types of patient goals canbe used as a tool to inform physicians about the potentially obscure,counter-intuitive, and seemingly counterproductive motivations ofpatients. The patient goals can also reveal the necessity of taking abroad, psychobiosocial view of the patient such that the user cancompletely understand and adequately address the patient's trueconcerns.

In an exemplary embodiment, upon completion of a goal, the user's statuswithin the medical simulation can improve. The user's status can beimproved by enhancing his/her avatar, by increasing his/her salarywithin the medical simulation, by giving him/her a promotion, orotherwise advancing/enhancing the professional status of the user.Alternatively, the user's training within the medical simulation can becompleted when a goal is achieved. In another exemplary embodiment, thegoal(s) for the user can be established by the system, by a medicalprofessor, by colleagues of the user, by the user, by patients, and/orby a medical examination board. In one embodiment, the goal(s) can beestablished based at least in part on the received personal informationregarding the user.

In an operation 120, the user is presented with a medical scenariowithin the medical simulation. In an exemplary embodiment, the medicalscenario can be a physician/patient interaction in which the user playsthe role of either the physician or the patient. Alternatively, themedical scenario can be an interaction between a physician and relativesof a patient who has undergone surgery, been diagnosed with a terminalillness, passed away, or been successfully treated. The medical scenariocan also be an interaction between an emergency medical technician andan accident victim at the scene of an accident, an interaction betweenan emergency room desk attendant and an individual seeking admittanceinto the emergency room, an interaction between a medical facilityadministrator and a bill collector, an interaction between medicalpersonnel and an insurance company, or any other interaction which canoccur in the medical profession. Medical scenarios are described in moredetail with reference to FIG. 3.

In an operation 125, the system identifies performance data based on anact of the user during the medical scenario. The performance data can beany information related to the user's behavior during the medicalscenario which can be used to grade, score, view, or otherwise evaluatethe user. For example, the performance data can be an audio and/or videocapture of the medical scenario which is capable of being replayed fromany point of view by an evaluator. The performance data can also betiming information based on occurrences within the medical scenario,accuracy data based on statements made by the user during the medicalscenario, accuracy data based on a diagnosis made by the user, accuracydata based on a test run on a patient by the user, feedback from anyparticipants in or viewers of the medical scenario, professor comments,decisions made by the user, metrics regarding the user's style ofinteraction, etc. The performance data can also include eye movements ofthe user. For example, a camera can be used to track the user's eyemovements during a medical scenario to determine whether the user ismaking eye contact with a patient, looking down at the ground, rollinghis/her eyes, etc. Similarly, in embodiments in which speech is used,the performance data can include voice analysis data. For example, amicrophone and a speech analyzer can be used to detect a stress level ofthe user, a nervousness level of the user, a tone of voice (i.e.,friendly, hostile, etc.) of the user, and so on. In one embodiment, acamera may be used to capture the user's eye movements, facialexpressions, body language, and other body movements. The capturedmovements/expressions can be attributed to the user's avatar in realtime such that the avatar mimics what the user is doing in thereal-world. Any or all of the captured movements/expressions can also beused as performance data to evaluate the user.

As an example, a medical scenario can be an interaction between apatient and a physician in an examination room of a medical clinic. Thephysician can be a first user, and the patient can be a second user or acomputer controlled patient, depending on the embodiment. The physiciancan elicit symptom information from the patient, perform tests on thepatient, access medical literature, make a diagnosis based on thesymptom information, provide the diagnosis to the patient, and/orrecommend one or more treatment options to the patient. The performancedata can be based on the physician's sincerity when speaking with thepatient, questions asked by the physician, the physician's level ofseriousness, the physician's responses to questions asked by thepatient, the physician's handling of phone calls or pages during thepatient examination, the level of trust which the physician engenderedin the patient, the punctuality of the physician, the physician'sability to detect falsehoods from the patient, and/or the responsivenessof the physician. Physician characteristics such as sincerity, trust,and seriousness can be operationally defined such that they can bemeasured and used as part of the user's evaluation. The performance datacan also be based on the accuracy of the physician's diagnosis, theaccuracy of tests run by the physician, the accuracy of the treatmentrecommended by the physician, etc. In an exemplary embodiment,performance data can also be captured based on the patient's actionsduring medical scenarios in which the patient is also a user.Performance data of a patient can be used to ensure that the patient isacting realistically, is responding appropriately, and is not incollusion with the physician.

In an operation 130, the user is evaluated based on the performancedata. In an exemplary embodiment, the user can be evaluated (orassessed) by a professor, a superior, a medical board, a testing agency,or any other individual(s) associated with the user. Alternatively, theuser can be evaluated by the system. The evaluation, which can beobjective or subjective, can be based on any criteria established by theevaluator(s). In one embodiment, the user can be evaluated by comparinghis/her handling of a medical scenario to the handling of the medicalscenario by one or more medical experts. The user can be evaluated aftereach medical scenario in which the user participates, afterparticipation in a predetermined number of medical scenarios, at anestablished time such as the end of a semester, and/or randomly. In oneembodiment, the user can be evaluated to determine whether the user hasachieved the goal provided to the user in operation 115.

In an exemplary embodiment, regular users such as medical student usersmay be limited in their ability to access and/or alter archivedinformation regarding occurrences within the medical simulation.Training administrators and other special users may be provided withexpanded or unlimited access such that they can effectively evaluateother users. For example, a medical student user may not be able view oralter a patient interaction in which he/she participated. A professor ofthe medical student may be given the ability to replay the patientinteraction from any point of view, add commentary to the patientinteraction, and/or alter the patient interaction such that the medicalstudent user can be shown his/her mistakes.

In an exemplary embodiment, access to and within the medical simulationcan be broken down into categories including observer access, limitedstudent access, standard student access, assistant instructor orprivileged student access, professor access, simulation administratoraccess, and developer access. An observer can refer to an individual whowatches others participate in the medical simulation, but who does nothis/herself participate. Observer access allows the observer to followan individual avatar in the medical simulation and view interactions ofthe avatar from a third person point of view. The observer is not ableto communicate with the avatar, control the avatar, or otherwise affectany part of the medical simulation. The observer may be a professor whowishes to introduce his/her class to interactions within the medicalsimulation.

Users with limited student access may have access to only a limitedportion of the medical simulation or only to certain avatars within themedical simulation. Alternatively, limited student access may includefull access to the medical simulation for only a limited amount of timeper day or per week. As an example, a limited student may be a pre-medstudent who is only allowed to play the role of a patient within themedical simulation. Standard student access can provide participantswith the ability to fully control one or more physician avatars and oneor more patient avatars within the medical simulation. The standardstudent can fully participate in physician/patient interactions.Assistant instructor or privileged student access can be granted toteaching instructors or exceptional students. This level of accessallows the user to slightly bend the rules of the medical simulation forthe sake of learning. Professor access allows the professor to start newsimulation sessions, observe students, and take over student avatars.Professor access also allows the professor to edit a student's records,alter a student's access level, and alter a student's in-game abilities.Simulation administrator access allows the simulation administrator tochange any variables, records, etc. regarding the medical simulationwhich do not require changes to the source code. Developer access allowsthe developer to have full and complete access to the medicalsimulation, including the ability to alter the source code of themedical simulation.

In an operation 135, feedback is provided to the user. The feedback canbe generated by the system, provided by an evaluator, and/or provided bya participant in a medical scenario in which the user participated. Thefeedback can be in the form of a score, grade, comment, or any otherindicator of the user's performance within the medical simulation. Inone embodiment, feedback can be provided as commentary along with anaudiovisual replay of the medical scenario for which feedback is beingprovided. Feedback can also occur in the form of negative and positiveconsequences within the medical simulation. For example, if the user isable to successfully convince a patient to take his/her medicine, thepatient may be cured of his/her ailment. If the user is unable toconvince the user to take his/her medicine, the patient may end up in acoma, and the patient's family may sue the user for medical malpractice.As such, the medical simulation provides users with an experiential,constructivist learning model. Feedback can be provided to the user atany time during or after the medical scenario. In one embodiment,feedback can be instantly provided by the system or a monitor when theuser makes a serious or fatal mistake during a medical scenario.

Feedback in the form of consequences within the simulation providesusers with experiential learning. In addition to consequences resultingfrom physician/patient interactions, the consequences may also resultfrom a variety of user actions and choices within the simulation. Forexample, a user who discovers and explores a Korean neighborhood withinthe simulation, may develop a better understanding of Korean culture,Korean attitudes towards life and death, family relationships, the useof herbs and other complementary medical techniques by Koreans, etc. Theconsequence of this discovery may in turn impact an interaction with aKorean patient that the user is treating. As another example, a user maydecide to do a home visit for a seemingly noncompliant diabetic patientand discover that the patient lives in a homeless shelter. As a result,the system may guide the user such that he/she learns about health careoptions for the indigent or how/where to obtain free medication for theindigent such that the patient can be successfully treated. The homevisit may even lead the user to attempt to effect political changewithin the simulation by creating or expanding a free clinic for theindigent. It can thus be appreciated that the simulation is dynamic andable to provide a user with challenges based on areas in which thesystem perceives that the user needs improvement.

In an operation 140, a decision is made regarding whether the userachieved the provided goal. If the user has not achieved the providedgoal, the system can present the user with another medical scenario inoperation 120, and the process can be repeated until the user achievesthe goal. If the user has achieved the provided goal, the system canincrease the user's status within the medical simulation in an operation145. The user's status can be increased by increasing the user's skilllevel(s), increasing the user's salary, enhancing the user's avatar,increasing the professional prestige of the user, increasing the medicalskill set of the user, lowering a malpractice rate of the user,increasing the number of patients of the user, and/or otherwiseadvancing the user. In an exemplary embodiment, the user can be providedwith a new goal in operation 115, and the process can be repeated untilthe user achieves the new goal. Alternatively, upon achieving theprovided goal, the user may be finished with his/her training within themedical simulation.

FIG. 3 is a diagram illustrating components of a medical training system300 in accordance with an exemplary embodiment. Additional, fewer, ordifferent components can be included in alternative embodiments. Medicaltraining system 300 can include a medical setting engine 305, a medicalscenario engine 310, a reference engine 315, a diagnosis engine 320, aconsultation engine 325, a capture engine 330, an assessment engine 335,a financial engine 340, an external engine 345, and a personal lifeengine 350.

In an exemplary embodiment, medical setting engine 305 can be used toprovide and maintain a medical setting in which medical scenarios cantake place. The medical setting can be a medical clinic, a hospital, anemergency room, a patient's home, an accident site, a natural disastersite, a private practice, or any other location in which a medicalpractitioner may be called upon to practice medicine. Alternatively, themedical setting can be any other location in which a physician, patient,or medical staff member may go during the course of practicing medicineor seeking medical treatment. In an exemplary embodiment, medicalsetting engine 305 can provide a plurality of medical settings such thatthe medical simulation is more realistic. For example, a physician mayhave a first appointment at a first clinic at 2:00 pm, a secondappointment at a second clinic at 3:30 pm, and a third appointment at ahospital at 5:00 pm. In an exemplary embodiment, the medical settingscan be part of a seamless continuum of the simulated world.Alternatively, medical settings may occur as discrete, single user orgroup instances within the simulated world.

In an exemplary embodiment, at least one medical setting within themedical simulation can be a clinic. The clinic can include a receptiondesk with a receptionist, a patient waiting area, a screening area, anursing station, a plurality of physicians' offices, a plurality ofpatient examination rooms, a clinic manager's office, a patientcheck-out area, an on-site laboratory, etc. In one embodiment, thereceptionist, janitors, and other staff members can be computercontrolled simulations. Alternatively, any or all of the staff memberscan be played by system users. For example, the receptionist can be auser, and medical training system 300 can be used to train the user suchthat he/she becomes accustomed to handling patients, collectinginsurance information, taking phone calls, scheduling follow up visits,and/or performing any other tasks expected of a receptionist.

In another exemplary embodiment, the clinic can also include a pluralityof virtual computer terminals through which an electronic health record(EHR) system can be accessed by physicians. Physicians can use the EHRsystem to access a patient's personal information, insuranceinformation, laboratory reports, x-ray data, consultant reports, and/ormedical history. Physicians can also use the fully functional EHR systemto order laboratory tests, to enter prescriptions, to obtain, complete,and/or dispatch standard forms (i.e., back-to-work, disability, schoolnotes, etc.), to automatically set up ‘tickler’ files to remind thephysician when patient studies and follow-up visits are due, to collectand/or analyze information regarding populations of patients withchronic conditions, etc. The EHR system may provide full coding featuresfor billing purposes. The EHR system can also include a virtualconference feature such that users can form care teams and work ingroups. The virtual conference feature can allow a plurality of users tosimultaneously review patient information, consult an expert, hold aroundtable discussion, or otherwise communicate with one another. In oneembodiment, the EHR system may include information regarding areal-world patient, and the virtual conference feature may be used byreal-world physicians to communicate about treatment of the patient.

The computer terminals within the simulation can also be informationportals through which physicians can practice medicine and/or learnabout the medical field. Users can also use the computer terminals toacquire timely information about their patient(s), their colleagues, orany psychobiosocial topic that is relevant to the challenging problemswithin the simulation. The information may be provided by contentexperts in a synopsized, contextualized form. The information may alsobe provided through links to a simulated or real-world biomedicallibrary. In one embodiment, each examination room within the clinic caninclude a virtual computer terminal (i.e., information portal) such thatthe physician can retrieve and/or enter data as the physician isexamining the patient.

The clinic can also have a flag system in place such that users areprovided with visual cues indicating the status of rooms within theclinic. For example, a blue flag outside of an exam room can indicatethat a nurse is prepping a patient for a visit, a green flag canindicate that a patient is waiting to be seen, a yellow flag canindicate that a physician is in the exam room with the patient, a redflag can indicate that the physician is finished with the patient andthe patient is ready for checkout, a white flag can indicate that labtests are needed for the patient, a black flag can indicate that x-raysare needed for the patient, a brown flag can indicate that the exam roomneeds to cleaned and prepared for the next patient, and so on. Inaddition, the clinic can be ergonomically sound, wheelchair accessible,in compliance with any applicable real-world building and/or designcodes, and decorated with calming colors and décor that reflects thecurrent standard in intelligent real-world clinic design.

Medical scenario engine 310 can be used to implement a medical scenariowithin one of the medical settings. In an exemplary embodiment, themedical scenario can be an interaction between a physician and apatient, and the roles of the patient and/or the physician can be playedby users. Alternatively, the roles of the patient and/or the physiciancan be played by computer controlled characters. Such computercontrolled characters can be designed to incorporate cognitive andemotional systems such that they behave like human physicians andpatients and are as believable in their roles as human physicians andpatients. In an alternative embodiment, the medical scenario can be anyother interaction between patients, physicians, medical staff, and/orother individuals who may be encountered during the day-to-day practiceof medicine. For example, the medical scenario can be an interactionbetween the physician and his/her superior, an interaction between thephysician and the head of accounting at his/her place of employment, aninteraction between the physician and a family member of the patient, aninteraction between the physician and a malpractice attorney, aninteraction between the physician and a subordinate, an interactionbetween the physician and an insurance representative, an interactionbetween the physician and a pharmacist, an interaction between thepatient and a receptionist, an interaction between the patient and afamily member, etc.

The scenarios encountered by users of the simulation are not limited tointeractions within the medical clinic or facility. Further, thescenarios are not limited to interactions with other users or computercontrolled avatars. The scenarios can take place in whole or in part atany location within the simulation, and may include any character orthree-dimensional construct within the simulation/synthetic world. As anexample, a scenario may include a user going to a patient's home todetermine whether the patient's walls contain asbestos which may beaffecting the patient's health. The scenario may also include going tothe patient's virtual neighborhood to determine whether there ispollution present, or to see whether the patient lives near a nuclearpower plant, a mosquito-infested pond, or a moldy hay barn. In anexemplary embodiment, augmented reality devices such as personal digitalassistants (PDAs), pagers, cellular telephones, etc. can be used in thescenarios to introduce real-world elements and/or tasks into thesimulation.

In an exemplary embodiment, the medical scenarios can be in the form ofvirtual face-to-face interactions, virtual telephone interactions,virtual email interactions, or any other virtual communications. As anexample, a physician can receive an urgent page from a pharmacistrequesting clarification of a prescription while the physician is in themiddle of a face-to-face consultation with a patient. Similarly, thephysician can receive an angry phone call from his/her superior whilethe physician is in the middle of a telephone call with the pharmacist.The physician can also receive telephone calls from laboratorytechnicians, receive telephone calls from patients, receive letters frommedical boards, receive emails from nurses, etc.

Medical scenario engine 310 can provide medical scenarios which are onetime occurrences and/or medical scenarios which develop and continueover a period of time. As an example of a one time occurrence, a patientcan visit a physician because the patient has an embarrassing rash onhis/her arm. The physician can diagnose the rash, prescribe an anti-itchcream to the patient, and tell the patient to return if the rash has notdisappeared within ten days. If the diagnosis and prescription werecorrect, the patient may not return and the physician may not havefurther contact with the patient.

As an example of a continuing medical scenario, the physician can see arecalcitrant diabetic patient who refuses to eat properly or takemedicine. The physician can have a goal of changing the diabeticpatient's attitude during visits which occur over a series of days,weeks, or months. The goal can also involve one or more tasks which areoutside of the actual physician/patient interactions, but which arerelated to the physician/patient relationship. For example, the patientmay not be able to afford medication. The physician may have to doresearch to determine how the patient can obtain free or discountedmedicine. If the physician does not perform the research and provide thepatient with the information, the patient on ensuing visits may becomemore contentious or withdrawn, may schedule visits more (or less)frequently, may show deteriorating control of his/her disease, or maytransfer his/her care to another physician. Alternatively, the physicianmay have to visit the patient at home to determine that the patientlives in a homeless shelter, that the patient is indigent, and that thereason the patient's condition is not improving is because the patientcannot afford medication. Upon making this determination, the physiciancan use resources within the simulation to research how the patient canreceive free or discounted medication. Medical scenario engine 310 canprovide consequences based on the physician's handling of the diabeticpatient. For example, if the physician does not properly handle thediabetic patient, the diabetic patient may eventually go into a coma,die, be involved in a car accident due to fainting behind the wheel, orotherwise suffer from his/her illness. However, if the physician is ableto turn the diabetic patient around, the diabetic patient can go on tobecome a successful businessman, an accomplished athlete, or a goodstudent.

In one embodiment, medical scenario engine 310 can provide the physicianwith a teaser before, during, or after the physician's first meetingwith a patient. The teaser can be set in the future and can illustrateconsequences which may result from the physician's handling of thepatient. For example, the patient can be a 16 year old boy with diabeteswho loves to skateboard, but refuses acknowledge his condition or takeany medicine to alleviate it. Prior to the boy's first visit with thephysician, the physician can be shown a teaser which portrays eventsthat will occur three months in the future if the boy does not begintaking his medicine. The teaser can show the boy preparing to perform ina televised half-pipe skateboarding competition. The boy's family,friends, and girlfriend can be in the stands to cheer for the boy andgive him support. The boy can begin his run in perfect form and thecrowd can raucously applaud. Toward the end of his run, while in themiddle of a difficult mid-air trick, the boy can faint and fall twentyfeet, head first to the ground. An ambulance can come and rush thebleeding boy to a hospital as his family loses control. In an exemplaryembodiment, use of such a teaser can help the physician becomeemotionally attached to the patient such that the physician sincerelycares about the patient's welfare. The use of the teaser can alsoprovide incentive to the physician to ensure that the portrayedcatastrophe does not come to fruition. The teaser can also be used toteach the physician that his/her performance in the office can havefar-reaching effects on numerous lives. In an exemplary embodiment, theteaser can be provided to the user in the form of audio information,video information, textual information, or any other format.

In an exemplary embodiment, the dialog which occurs between participantsin a medical scenario can be conveyed through a headset (or otherspeaker) and microphone worn by the participants in the medicalscenario. For example, a patient can use his/her microphone and headsetto speak to the physician and hear the actual voice of the physician.Similarly, the physician can use his/her microphone and headset to speakto the patient and hear the actual voice of the patient. In oneembodiment, full natural speech language processing may be used, and theuser may be able to speak to a computer controlled avatar about anytopic within the simulation. Alternatively, domain specific speechrecognition may be used such that the user can only speak with thecomputer controlled avatar about a limited number of topics. Forexample, if medical domain specific speech recognition is used, the usercan converse with a computer-controlled patient about a host of medicaltopics. However, the user may not be understood by the system if he/sheattempts to talk with the computer-controlled patient about baseball. Ifthe user attempts to talk baseball, the computer controlled patient maycorrect for this by becoming upset, asking the physician to repeat thestatement, or steering the physician back to the reason for the visit. Aspeech analyzer can also be used to analyze the user's voice forevaluation purposes. The speech analyzer can detect nervousness, stress,tone, or any other voice characteristic known to those of skill in theart. These voice characteristics can be used to condition theuser/patient interaction. In addition to speech analysis, a camera maybe used to capture user movements, expressions, and body language, andthe captured information can be attributed to the user's avatar in realtime such that the avatar behaves as the user is behaving in thereal-world. The captured information can also be used to evaluate theuser, to ensure that the user takes the simulation seriously, and tocondition the user/patient interaction.

In an alternative embodiment, the dialog which occurs betweenparticipants in a medical scenario can be scripted or canned, and in theform of dialog trees. The use of pre-selected dialog can ensure thatsymptom descriptions and responses to questions are appropriate,regardless of the medical knowledge of the participants. In addition, adialog which is pre-written by medical professionals can be made toaccurately reflect patients based on their age, ethnicity, emotionalstate, and medical condition. The dialog trees can be implemented in theform of multiple choices from which participants can select. Forexample, a patient can complain of a symptom through text in a dialogbox. The physician can have the choice of asking for more detailsregarding the symptom, asking how long the symptom has persisted,excusing his/herself to consult with a colleague, or making an immediatediagnosis. The patient's response can be based at least in part on thephysician's response, and so on. The patient can be a system user who isalso choosing his/her dialog, or a computer controlled patient whosedialog is based on the dialog selections made by the physician.

Dialog trees can alleviate the need for convincing and realistic acting,and can also allow users who speak different languages to interact withone another. Medical training system 300 can include a translatingengine such that each participant sees dialog text in his/her nativelanguage. Anonymity within medical training system 300 can also bemaintained through the use of dialog trees. Anonymity can make itsignificantly more difficult for users to cheat the system by workingtogether with other users. Dialog trees can also simplify the assessmentof participants. Medical training system 300 can know which dialogchoices are sub-optimal, and evaluate participants accordingly. In oneembodiment, the medical training system can have a plurality of modes. Abeginner mode may use dialog trees, and intermediate or advanced modesmay use free form speech.

In an exemplary embodiment, player emotions and/or feelings can begraphically modeled during a medical scenario. Graphical models ofemotions and feelings can be used in embodiments which utilize dialogtrees and/or in embodiments which utilize free form speech. For example,during an interaction between a physician and a patient, the physicianmay be able to see a graphical representation of a trust level of thepatient. The physician can also see how his/her responses to the patientaffect the trust level. If the physician answers a question in a waythat avoids the question, the trust level can decrease. Conversely, ifthe physician takes five minutes to provide a thorough explanation tothe patient, the trust level can increase. In an exemplary embodiment,any other feelings and/or emotions, including anger, nervousness, fear,joy, happiness, morale, and so on, can also be graphically represented.In one embodiment, patients may be able to see a graphical model of theemotions and/or feelings of their physicians. In another alternativeembodiment, graphical models can be used in medical scenarios involvinginteractions between a physician and his/her superior, a physician and acolleague, a patient and a receptionist, or any other medical scenarios.Alternatively, any or all physician and patient characteristics can beconveyed through body language, facial expressions, speech, etc.

In one embodiment, physicians may be prompted if a patient or otheravatar with whom they are interacting supplies partial ormisinformation, or is otherwise untruthful. The prompt can be a colorindicator, a textual message, or any other type of indication. As anexample, the physician may ask a patient if he gets any regular exercisethroughout the course of an average day. The patient may respond that ofcourse he does. The physician may be informed (through a text box,pop-up window, audio message, color indicator, etc.) that in truth, theonly exercise that the patient gets is walking from his couch to hisrefrigerator. The physician can use such information to flush out thetruth from the patient, to diagnose the patient, and/or to prescribe atreatment for the patient. The truthful information can also be used toallow the physician to better understand patient motivations and patientinsecurities. In an exemplary embodiment, prompts regarding the truthunderlying a physician/patient interaction may only be provided tonovice users within a beginner mode. More advanced users may be expectedto determine whether a patient is lying without any prompts or hints.

In one embodiment, an enhanced scenario replay may be used to providefeedback to the physician after the medical scenario. In an enhancedscenario replay, arrows or other indicators can point to body language,facial expressions, etc. of the patient that should have cued thephysician to the patient's internal state. The physician can click onthe arrows to view additional information regarding the specific bodylanguage, facial expression, etc. Alternatively, a live tutor orprofessor can go through a replay of the interaction with the user andexplain any cues or other information which the user missed. In anotheralternative embodiment, a live tutor or professor can accompany the userwithin the medical scenario and stop the scenario at critical times topoint out important cues/information which the user missed.

Reference engine 315 can be used to provide a full spectrum ofpsychobiosocial medical information to physicians in the medicalsimulation. The medical information can be provided by content expertsin timely, synopsized, and contextualized form. Alternatively, themedical information may be provided through links to real-world datasources such as an online encyclopedia. The medical information can beused as a resource for diagnosing illnesses, identifying problems,recommending treatments, successfully solving challenging problems posedin physician/patient interactions, etc. Physicians can access themedical information through virtual computer terminals within themedical simulation, through a pop-up screen, or by any other method. Themedical information can be also be in the form of access to biomedicaljournals, textbooks, and other medical publications. The medicalinformation can also be in the form of links to medical websites. In oneembodiment, the medical information which is accessible may depend onthe user and/or the version of the medical simulation. For example, auser who is a member of the general public may receive links to medicalwebsites, a user who is a medical student may receive online textbooks,and a user who is a practicing physician may receive medical journals,textbooks, and encyclopedias. The medical information provided may alsodepend on a level of experience of the user. For example, a novice usermay be provided with detailed, complete, and easily accessibleinformation from a single source. A more advanced user may be forced toutilize a plurality of sources to find desired information such thatreal-world research is emulated. In one embodiment, reference engine 315can allow users to customize a virtual terminal or other access pointsuch that the medical information is organized into a personal library.In an alternative embodiment, medical information may not be provided tousers such that users are forced to rely on their own medical knowledge.

In an exemplary embodiment, medical training system 300 may not requireuser physicians to diagnose their patients because diagnosis is a skillwhich can be adequately taught in medical school. Rather, a primaryfocus of medical training system 300 can be to enhance the ability ofphysicians (or physicians in training) to successfully interact withpatients. As such, once physicians ask patients the proper questions andperform the proper tests, diagnosis engine 320 can be used to provideusers with a diagnosis based on the patient symptoms. Diagnosis engine320 can be used as an alternative to, or in conjunction with referenceengine 315, depending on the embodiment. In one embodiment, diagnosisengine 320 may be used only in specific versions the medical simulation,or only for specific users. For example, diagnosis engine 320 may beavailable for a user from the general public and a user in his/her firstyear of medical school, but not for a user who is a practicing physicianseeking continuing medical education credits.

Consultation engine 325 can allow a user to consult with other users ofthe medical simulation, with live medical experts, with computergenerated tutoring agents, etc. For example, a user may wish to speakwith other users regarding how to handle a patient who is lying, asuperior who is suggesting unethical conduct, a problematic pharmacist,etc. Users can also consult with live, real-world expert consultants whomay variously be represented as avatars, through video, and/or throughaudio. As an example, a medical student user may be able to consult withone of his/her professors, a practicing physician, or a medicalspecialist. Other experts which may be accessible through the medicalsimulation can include psychologists, social scientists, medicalanthropologists, population health experts, and so on. Consultations cantake place in the form of a virtual chat room with actual speech,through text messages, through virtual telephone calls, or by any othermethod of communication. In one embodiment, the medical simulation caninclude a virtual conference room in which users can go to seek help,information, and guidance from other users. The virtual conference roommay exist as a component of the Electronic Health Record (EHR) systemwithin the simulation. Alternatively, the virtual conference room may bea three-dimensional construct within the simulation that exists apartfrom the EHR, and which features a virtual computer terminal (i.e.,information portal) or other construct through which users can readilyaccess information.

Capture engine 330 can capture and store data corresponding to eventswhich occur in the medical simulation. The captured data can beperformance data used to evaluate users and/or any other data whichtracks users' actions within the medical simulation. In one embodiment,capture engine 330 can store all interactions which occur in the medicalsimulation such that the interactions can be replayed and reviewed. Thereplay of an interaction can be from any perspective such that a usercan view facial expressions and body language of his/her avatar or suchthat a professor can simultaneously view all participants in theinteraction. Users may also be able to view replays of medical scenariosin which they did not participate such that the users can learn from themistakes and successes of other users.

In an exemplary embodiment, data stored by capture engine 330 can beused by medical training system 300, a professor, a medical board, orany other entity to grade users based on their performance during amedical scenario. Capture engine 330 may also be used to capture timinginformation of events which occur within the medical simulation. Timinginformation can include the amount of time it takes for a physician tomake a diagnosis, whether the physician or patient is late for anappointment, the length of an appointment, an amount of time which thephysician waits for a silent patient to speak, an amount of time spentlistening to the patient, etc. Capture engine 330 can also be used tocapture and store questions asked during consultation, medical referencematerials, journal articles, etc. used to make a diagnosis, user actionswithin the simulation which occur apart from the actualphysician/patient interaction, and any other information associated withthe simulation.

Assessment engine 335 can be used by medical training system 300 toprovide an assessment of users based on their performance in the medicalsimulation. The assessment can be based on responses made during medicalscenarios, answers to questions, punctuality, responsiveness, a rate ofpatient satisfaction, etc. Assessment engine 335 can also be used todetermine whether a user has satisfied a goal. If the user satisfies thegoal, assessment engine 335 can increase the user's status, increase theuser's salary, increase the user's skill level(s), promote the user, orotherwise reward the user within the medical simulation. As such, themedical simulation provides users with an experiential, constructivistlearning model. In one embodiment, the assessment can be made at leastin part by a professor or other evaluator of the user, and assessmentengine 335 can receive assessment data from the evaluator. For example,assessment engine 335 and/or capture engine 330 can allow a professor toview, annotate, and otherwise comment upon a medical student user'sperformance during a medical scenario. If the user's performance wassatisfactory and/or a goal was met, assessment engine 335 can increasethe user's status accordingly.

Assessment engine 335 can also be used to determine and causeconsequences within the simulation based on actions of the user withinthe simulation as he/she drives toward an ultimate or overarching goal.The consequences can be based on the handling/treatment of patientsduring patient interactions, information conveyed to patients, actsperformed outside of patient interactions such as visiting the patient'shome, responsiveness to patient telephone calls, the amount of effortplaced in finding a solution for patients, and/or any other actionstaken by the user within the simulation. As such, assessment engine 335is a dynamic, iterative engine which can be used to alter a user'sexperience within the simulation by generating consequences that helpthe user to better understand the benefits or problems involved with theuse of different strategies/techniques. The consequences can also beused to ensure that the user receives experience in areas where the userhas performed poorly in the past.

Financial engine 340 can be used to track finances within the medicalsimulation. A user may be a clinic manager whose goal is to operate theclinic on a specific budget. Financial engine 340 can be used to keeptrack of the budget, keep track of clinic income, keep track of clinicexpenditures, keep track of clinic liabilities and bills, and any otherfinancial information of the clinic. Financial engine 340 can also beused to keep track of salary and expenses for individual users such thatthe user's financial status can be monitored. In one embodiment,financial status of individual users can be used in part to determine anoverall quality of living for the users within the medical simulation.Financial engine 340 can also be influenced by assessment engine 335based on the user's actions within the simulation. For example, a user'sactions may impact patient satisfaction, patient waiting times, and thestress of nurses or other clinic personnel, and clinic revenue may beimpacted accordingly. If patients are happy and there is a satisfiedstaff with low turnover, clinic revenue may be high. If patients areunhappy, they may not return, and the clinic revenue may be low.Financial engine 340 may also be used to economically represent avariety of different healthcare systems such that users can obtainexperience in different settings. For example, financial engine 340 maybe used to represent a free market healthcare system, any of a varietyof socialized healthcare systems, or any other type of healthcaresystem. In one embodiment, users may be allowed to alter healthcarepolicy assumptions within the simulation to see how various policiesaffect the economics of the healthcare system. In an alternativeembodiment, financial information may not be considered within themedical simulation.

External engine 345 can be used by medical training system 300 to modelany outside influences which can potentially affect physicians and/ormedical settings within the medical simulation. External engine 345 canbe used to show how natural disasters, terrorist attacks, and othercatastrophic events can affect operations within a medical setting.External engine 345 can also be used enforce legal obligations ofphysicians and the medical settings in which they work. External engine345 can be used to implement changes in health regulations which mayresult from governmental or internal action. External engine 345 canalso introduce the element of competition such that one or more clinics,hospitals, or private practices compete against one another for patientswithin a specific region. External engine 345 can also modelrelationships between clinics and health insurance companies,relationships between physicians and malpractice insurance carriers,relationships between clinics and professional associations,relationships between physicians and professional associations, and soon.

Personal life engine 350 can be used by medical training system 300 tocontrol any aspect of the personal lives of users within the medicalsimulation. For example, users can have homes, families, vehicles,relatives, chores, hobbies, pets, and so on within the medicalsimulation. As such, users can get a feel for what it is like to livethe life of a physician and/or a patient. In one embodiment, thepersonal life engine 350 may be used in only certain versions or onlyfor specific users of the medical simulation. For example, detailedpersonal lives may be an option in a medical simulation designed for thegeneral public, but not for a medical simulation designed for practicingphysicians who are trying to obtain continuing medical educationcredits. In an alternative embodiment, personal life engine 350 may notbe used, and the medical simulation may focus solely on the professionallives of physicians.

In an alternative embodiment, medical training system 300 may alsoinclude a body language engine. The body language engine can ensure thatan avatar's facial expressions, posture, and other body language isappropriate to what the avatar is saying and what the avatar is feeling.For example, the body language engine can ensure that an avatar who hasrecently experienced a death in the family appears unenergetic, distant,and melancholy. The body language engine can also control body languagebased on past interactions and experiences of the avatar. For example,if a prior interaction between a patient avatar and a physician avatarwas friendly and productive, the patient avatar can exhibit friendly andhappy body language at the commencement of a subsequent interaction withthe physician avatar. Similarly, if a prior interaction between thepatient avatar and the physician avatar was disastrous, the physicianavatar can exhibit nervous and slightly angry body language at thecommencement of a subsequent interaction with the patient avatar.

In alternative embodiments, medical training system 300 can also includea registration engine, a goal engine, an emotion engine, an avatarengine, and/or any other engines which can be used to implement themedical simulation. For example, the registration engine can receiveregistration information from a user and provide the user with access tothe medical simulation. The goal engine can create, store, assign,and/or receive goals for the user. The goal engine can also track theuser's progress toward achieving the goal. The emotion engine can beused to convey emotions of the avatars based on past and presentexperiences of the avatars within the simulation. In the case of anavatar representing a live user, these emotions can influence dialogchoices presented to the user. In the case of a computer controlledavatar, the emotions can influence dialog used by the avatar. Avataremotions can also be conveyed non-verbally through body language,expressions, posture, textual indicators, other indicators, etc.Alternatively, emotion can be conveyed through the body language engine.The avatar engine can assign avatars to the user, receive avatarselections from the user, store avatar(s) for the user, and/or enhancethe avatars as time progresses and the user increases his/her status. Inan alternative embodiment, any or all of the engines described hereincan be incorporated into a single medical training engine.

As described above, the medical training system can be used to model awide variety of interactions which can occur among medical staff,medical management, physicians, patients, emergency medical technicians,receptionists, pharmacists, insurance companies, etc. In an exemplaryembodiment, the medical training system can be used as part of a coursewithin a medical school curriculum. The course, which can run for one ormore semesters, can require students to attend class for a number ofhours each week and participate in the medical simulation for a numberof hours each week. During the first class, the professor can talkstudents through an introductory demonstration of the medical simulationand have the students set up their medical simulation accounts. Thestudents can also be asked to establish their avatars and begin usingthe medical simulation. Experience within the medical simulation can begained by performing ramp-up quests, such as making introductions toother avatars within the medical simulation, executing simple taskswithin the medical simulation, pulling patient data within the medicalsimulation, and so on. Alternatively, students can gain experience bymeeting with one or more computer controlled patients. Upon gaining asufficient amount of experience, the student can begin to interact withlive and/or simulated patients in the medical simulation. The studentcan also play the part of a live patient within the medical simulation.During subsequent classes, the professor can show replays of and commentupon particularly good and/or particularly bad physician/patientinteractions. Professors can also answer specific questions and providephilosophical guidance regarding the medical simulation.

Over the course, students may be expected to increase their skills invarious areas such as interviewing, listening, cultural sensitivity,ethnic sensitivity, religious sensitivity, etc. Users may start with askill level of 1 in each of a plurality of categories. As a useradvances through a structured series of encounters with physicians andpatients, his/her skill level can increase based on how the user handlesthe encounters. The user may be required to attain a specific skilllevel in each category to pass and/or achieve a certain grade in thecourse. If the medical simulation is limited to a single class at aninstitution, there may be scheduled times during the week when studentsare encouraged or required to use the medical simulation. If the medicalsimulation is run across many medical schools, nationwide, or worldwide,usage times may not be scheduled because there will likely always beother available users who are playing the role of patients andphysicians.

As an example of a session in the medical simulation, user A may log inas a physician at 4:00. User A may have a varied range of skills, e.g.level 2 in Korean cultural sensitivity, level 3 in interviewingmicro-skills, and level 6 in augmented reflective listening. User A mayhave a scheduled appointment at 4:15 with a patient and a scheduledappointment at 4:35 with a physician. The patient can be computercontrolled, or played by another user. Prior to his meeting, user A maygo to his office to bring up files regarding the patient. User A candiscover that the patient is a 45 year old fish market manager who iscoming in for a checkup on his progress controlling a case of diabetes.User A can also be reminded that user A met with the patient a month agoand prescribed a combination of diet change and medication. Blood workdone on the patient can indicate that there has not been muchimprovement in the patient's condition since the last visit. User A canbe provided with an indication that the patient is waiting and ready ina designated examination room. User A can cause his avatar to walk tothe examination room.

Depending on the embodiment, user A can either speak a greeting to thepatient or select a greeting from one or more greeting options. Thegreeting options may include using the patient's name, refraining fromusing the patient's name, just saying hello, not using any greeting,offering a handshake, etc. If a live user is playing the role of thepatient, the patient can also either speak a greeting to user A orselect a greeting from one or more greeting options. The patient'sgreeting options may be based on the greeting selected by user A. User Acan have a goal of understanding if and why the patient has or has notbeen compliant with his/her medical regimen. The patient may have a goalthat conflicts with the goal of user A, such as convincing user A thathe/she is complying with his/her diet when in reality the patient is tooembarrassed to admit that he/she is confused by the diet. Similarly, thepatient may have a goal of convincing user A that the patient is takinghis/her medicine when in reality the patient has been laid off, has nohealth insurance, has only been taking one pill every third day, and istoo ashamed to discuss the issue.

Both user A and the patient can be awarded points for their actionsduring the simulation. For example, user A may be awarded points forhelping the patient to discuss his/her dietary noncompliance in a morehonest fashion, and additional points for developing an understanding ofwhy the patient did not follow his/her diet. Even if user A is not ableto elicit an admission from the patient, user A may still be awardedpoints for building trust, which may result in a more honest dialogduring future patient visits. In one embodiment, the dialog optionspresented to the users can be based on the user's skill level. Forexample, if user A has a high cultural sensitivity skill level, user Amay be able to accurately empathize with a patient regarding thepressure to eat ethnic foods that adversely affect the patient's bloodsugar, cholesterol, blood pressure, etc. User A may receive points forthis technique, and may receive progressively more points if he/she canhelp the patient re-think his/her diet, set milestones for patientimprovement, make referrals to an ethnically-savvy dietician, etc. Ifuser A polarizes the discussion such that the patient tunes thephysician out or becomes adversarial, user A may receive negativepoints, and adverse consequences may result. User A may also be awardedpoints if he is able to successfully conclude the appointment with thepatient well before 4:35 such that he can prepare for and attend hisnext appointment. A successful conclusion may be achieved if user A doesnot act rushed or make the patient feel neglected or unimportant.

In an exemplary embodiment, a patient's health within the medicalsimulation can be represented along an illness trajectory, which can beseen as a two-dimensional representation of the patient's health overtime. In another exemplary embodiment, the illness trajectory can beaffected by dependent variables associated with patients and independentvariables associated with physicians, thus creating a three-dimensionalmodel. Dependent variables of the patient may include anxiety, resistivebehaviors, and non-compliance. Independent variables of the physicianmay include rapport, patient-centeredness, cultural sensitivity, andcommunication skills. The independent variables associated with thephysician can affect the dependent variables of the patient, and thedependent variables can affect the illness trajectory of the patient.

As an example, rapport can be an independent variable associated with aphysician and defensive behavior can be a dependent variable associatedwith a patient. If, during a physician/patient interaction, thephysician exhibits good rapport, the defensive behavior of the patientmay be lowered. Because the defensive behavior is lowered, the patientmay more closely follow his/her medical regimen, and the patient'shealth may increase over time. The interactions of these variables andthe resulting health implications are an expression of thethree-dimensional illness trajectory model described above. Conversely,if the physician has poor rapport, the patient's defensive behavior mayincrease or remain unaltered, and the illness trajectory may reflect adecrease in the patient's health. Poor rapport by the physician and theresulting increase in defensive behavior can also result in otherconsequences within the simulation such as tasks which the physician isasked to perform, the timing of subsequent visits by the patient, thepatient's behavior or attitude during a subsequent visit, whether thepatient misses a visit, etc.

In an exemplary embodiment, independent variables associated with thephysician and/or dependent variables associated with the patient may bemade quantifiable through the use of surrogate markers, and measured bya statistical engine. As an example, rapport (i.e., an independentvariable associated with the physician which, per se, may be nebulous)may be quantified by x factors, where x can be any value. The factorscan include a type of clothing worn by the physician, a color of theclothing worn by the physician, a type of greeting used by thephysician, a type of handshake used by the physician, whether thephysician makes eye contact with the patient, whether the physicianshows up on time for the appointment, specific words used by thephysician, etc. During an interaction, the statistical engine candetermine how many of the rapport related factors are demonstrated bythe physician, and the physician can receive a rapport score. As anexample, there may be 15 factors used to quantify rapport, and thephysician may be considered to have excellent rapport if he/shedemonstrates 12 or more factors during an interaction. Similarly,demonstration of 9-11 factors may be good rapport, demonstration of 5-8factors may be average rapport, and demonstration of 0-4 factors may bebad rapport. If defensive behavior (i.e., a dependent variableassociated with the patient) of the patient is dependent upon thephysician's rapport, the defensive behavior can increase or decreasebased on the number of rapport factors exhibited by the physician.

FIGS. 4-8 are diagrams illustrating an exemplary physician/patentinteraction within a medical simulation. The diagrams in FIGS. 4-8 aretwo-dimensional depictions which are used for illustrative purposes. Itis important to understand that, in an exemplary embodiment, the medicalsimulation may be a three-dimensional world in which three-dimensionalavatars possess an extensive amount of detail, expression, cognition,emotion, and realism. Further, the three-dimensional world, which can bemodeled after the real world, may include numerous avatars with varyingattitudes, appearances, goals, and circumstances. FIG. 4 is a diagramillustrating a physician office 400 in accordance with an exemplaryembodiment. Physician office 400 includes a door 405, a window 410,artwork 415, a couch 420, a chair 425, a desk 430, a telephone 435, anda computer 440. In alternative embodiments, physician office 400 caninclude any other furniture, décor, reference materials, etc. such thatphysician office 400 appears genuine. In an exemplary embodiment,physician office 400 can be within a clinic, hospital, or other medicalfacility within the medical simulation.

A physician avatar 445 can be played by a user. Physician avatar 445 canbe a three-dimensional avatar which exhibits emotion and realisticfacial expressions. Physician avatar 445 can also exhibit confidence, ora lack thereof, based on the accumulated learning experiences of theuser within the medical simulation. For example, physician avatar 445may exhibit a low confidence level and/or low self esteem if the userhas performed poorly in previous physician/patient interactions.Similarly, physician avatar 445 may exhibit a high confidence leveland/or high self esteem if the user has excelled in previousphysician/patient interactions. Confidence level, self esteem, mood,emotion, etc. can be portrayed through realistic facial expressions,gestures, posture and/or other body language of physician avatar 445.Alternatively, any or all of confidence level, self esteem, mood,emotion, etc. can be portrayed through visible gauges, meters, or otherindicators. The gauges, meters, or other indicators may be visible toonly the user controlling physician avatar 445, to a subset of users, orto all users, depending on the embodiment. In an exemplary embodiment,avatar 445 can be created and/or represented through any combination ofreal time video capture, real time audio capture, real time motioncapture, full animation, the use of animation toolsets that automate theanimation process, etc.

In an exemplary embodiment, the user can log into the medical simulationand begin preparing to meet with a patient or perform other tasks. Inone embodiment, physician avatar 445 can start in physician office 400upon login. Alternatively, physician avatar 445 can be in a home, in anapartment, in another part of the medical facility, or anywhere elsewithin the medical simulation upon login. If physician avatar 445 doesnot start in physician office 400, physician avatar 445 can walk, bike,drive, etc. its way to physician office 400. In one embodiment, use ofan office such as physician office 400 may be limited to a subset ofusers within the medical simulation. For example, use of physicianoffice 400 may be a reward or privilege based on experience and progressmade within the medical simulation. Users without offices can beprovided cubicles, common areas, or other areas which provide thefunctionality of an office such that the users can receivecorrespondence, learn about patients, prepare for patients, etc.

In an exemplary embodiment, physician office 400 can be a location inwhich physician avatar 445 can prepare to meet with patients. Ifphysician avatar 445 has not previously met with a patient, physicianavatar 445 can use computer 440 to obtain general information about thepatient, the patient's medical history, and the reasons for the patientvisit. In one embodiment, physician avatar 445 can use computer 440 toexperience a teaser related to the patient. The teaser can providephysician avatar 445 with information regarding the patient's past, liesthat the patient has told or may try to tell, and/or potentialconsequences which may be realized in the future if treatment of thepatient is successful or unsuccessful. In addition, if physician avatar445 has previously met with the patient, physician avatar 445 can usecomputer 440 to recall what occurred in previous visit(s). Physicianavatar 445 can use telephone 435 to receive audio information fromnurses and other physicians, to receive alerts, to speak with patients,to speak with pharmacists, to obtain assistance from other users and/orexperts, etc. Physician office 400 may also include a pager, personaldigital assistant, cellular telephone, or other communication devicessuch that physician avatar 445 can send/receive e-mails, pages,voicemails, text messages, etc. both inside the simulation and betweenthe simulation and real world.

FIG. 5 is a diagram illustrating a reception area 500 in accordance withan exemplary embodiment. Reception area 500 includes a reception desk505, a receptionist stool 510, chairs 515, a magazine stand 520, and arestrooms sign 525. In an alternative embodiment, reception area 500 canalso include vending machines, restrooms, televisions, a fish tank, orany other items likely to be found in a genuine reception area. Patientschecking in to the medical facility can wait in chairs 515 and/or readmagazines from magazine stand 520 while waiting to be called to an examroom. The magazines can include links to real-world magazines, healthrelated websites, medical information, or any other information. Areceptionist avatar 530 is seated on receptionist stool 510 to helppatients check in to the medical facility. In an exemplary embodiment,receptionist avatar 530 can be a computer controlled avatar.Alternatively receptionist avatar 530 can be controlled by a user.Regardless of whether receptionist avatar 530 is computer or usercontrolled, receptionist avatar 530 can exhibit realistic facialexpressions and emotion, including impatience, friendliness, sincerity,anger, etc.

A patient avatar 535 can check in to the medical facility with theassistance of receptionist avatar 530. In an exemplary embodiment,patient avatar 535 can be played by a user. During check in, patientavatar 535 can provide personal information, insurance information,billing information, or any other information which is generallyprovided upon checking into a medical facility. In one embodiment, ifpatient avatar 535 has previously visited the medical facility, patientavatar 535 can review the results of any past meetings during the checkin procedure. Patient avatar 535 can also be briefed during check inregarding how to act and/or what to say during an upcoming meeting withthe physician.

In an exemplary embodiment, patient avatar 535 can exhibit emotion,facial characteristics, and/or other traits based on medical condition,experiences during past meetings with the physician, and/or occurrencesunrelated to the medical problem. For example, patient avatar 535 canexhibit sadness because of the death of a pet. Alternatively, patientavatar 535 may exhibit fear because the physician was mean andaggressive during a past visit. Alternatively, patient avatar 535 mayact arrogant, condescending, or skeptical because the physician made amistake during a past visit. Thus, it can be seen that the medicalsimulation is a dynamic environment in which the present behavior and/orfeelings of patient avatar 535 may be based on an accumulation of pastoccurrences and/or present circumstances.

In an exemplary embodiment, patient avatar 535 and receptionist avatar530 can communicate to one another through dialog boxes. Patient avatar535 can speak through a dialog box 540 and receptionist avatar 530 canspeak through a dialog box 545. Depending on the embodiment, dialog box540 and dialog box 545 may be visible to all users, may be visible toonly a subset of users, or may be visible only to patient avatar 535 andreceptionist avatar 530. Alternatively, dialog may be shown at a top ofa computer screen through which the medical simulation is accessed, at abottom of the computer screen, at a side of the computer screen, etc. Inan alternative embodiment, patient avatar 535 may communicate throughnatural speech, and receptionist avatar 530 may respond through computergenerated speech. In such an embodiment, domain specific speechrecognition may be used, and the scope of the conversation may belimited to ensure that the speech of patient avatar 535 can beaccurately recognized such that receptionist avatar 530 can respondappropriately. Alternatively, full natural speech processing may be usedsuch that conversation is not limited.

The following is an exemplary description of an interaction betweenpatient avatar 535 and receptionist avatar 530. Receptionist avatar 530can be in a good mood because all clinic staff was recently given araise. Patient avatar 535 can be impatient and slightly angry because ofa previous bad experience at the medical facility and a general dislikeof the medical profession. Patient avatar 535 can be in line behindother patient avatars (not shown) attempting to check in. When patientavatar 535 is first in line, receptionist avatar 530 can say “nextplease.” Patient avatar 535 can step up to reception desk 505 andreceptionist avatar 530 can smile at patient avatar 535 and say “hello,is this your first time seeing us?”. Patient avatar 535 can exhibit animpatient facial expression and answer “no, I have been here severaltimes in the past.” Receptionist avatar 530 can continue smiling atpatient avatar 535 and say “last name please.” Patient avatar 535 cansay and/or spell the requested last name. If patient avatar 535 does notneed to prepare for the upcoming physician visit, receptionist avatar530 can smile and say “thank you, please have a seat in the waiting areaand your name will be called shortly.” Alternatively, patient avatar 535may be provided with the option to prepare for the physician visit. Inan exemplary embodiment, each interaction between a patient and areceptionist interaction can be different. For example, next timepatient avatar 535 checks in, patient avatar 535 may be in a good mood,and receptionist avatar 530 may exhibit anger because of problems athome.

Once patient avatar 535 is checked in, patient avatar 535 can walkaround reception area 500, use a restroom (not shown), purchase a snackfrom a vending machine (not shown), sit in one of chairs 515, read amagazine from magazine stand 520, etc. At any time after check in, anurse or other staff member can contact patient avatar 535 and escortpatient avatar 535 to an exam room. When patient avatar is in the examroom and ready to be examined, an alert can be provided to physicianavatar 445 described with reference to FIG. 4. The alert can be a page,a telephone call, a text message, an e-mail, a pop-up text box, etc.Alternatively, an alert may not be provided, and physician avatar 445may be expected to go to the exam room at the time scheduled for theappointment.

FIG. 6 is a diagram illustrating a corridor 650 within the medicalfacility in accordance with an exemplary embodiment. Within corridor 650is a first exam room door 655 and a second exam room door 660. Firstexam room door 655 can include a first flag 665 to indicate the statusof the first exam room. Similarly, second exam room door 660 can includea second flag 670 to indicate the status of the second exam room. Asdescribed above, first flag 665 and second flag 670 can be used toprovide users with visual cues indicating the status of the exam roomsalong corridor 650. The visual cue can be a color of the flag, aposition of the flag, a shape of the flag, etc. The status may be anindication that the exam room is occupied by a patient, unoccupied, inneed of cleaning, ready for a patient, occupied by a nurse, occupied bycleaners, etc. Corridor 650 can also include a computer terminal 675such that users can access the EHR system, access information, and/orcommunicate with other users. A nurse avatar 680 can summon patientavatar 535 described with reference to FIG. 5 when an exam room isready. Nurse avatar 680 can be a live user or a computer controlledavatar. Nurse avatar 680 can communicate with patient avatar 535 and/orphysician avatar 445 according to any of the communication methodsdescribed herein.

FIG. 7 is a diagram illustrating an exam room 600 in accordance with anexemplary embodiment. Exam room 600 includes a medicine cabinet 605, asink 610, an examination table 615, and a computer terminal 620. Inalternative embodiments, exam room 600 can include any other itemslikely to be found in a genuine exam room. Physician avatar 445 cancommunicate through a dialog box 625, and patient avatar 535 cancommunicate through a dialog box 630. In an exemplary embodiment, theusers playing physician avatar 445 and patient avatar 535 can eachselect dialog from a plurality of dialog choices. Alternatively, patientavatar 535 may be computer controlled, and the computer can selectdialog based on the dialog used by physician avatar 445. The dialogchoices can be crafted by medical professionals who have substantialexperience in physician/patient interactions. As such, each interactionwithin the medical simulation can be tailored to emphasize a specificcircumstance and teach one or more specific skills. This tailoringallows medical students and young doctors to attain the equivalent ofyears of knowledge and experience through the medical simulation withoutmaking mistakes with real patients. In an alternative embodiment, themedical simulation can include language processing software such thatnatural speech can be used instead of dialog boxes.

As described above, present interactions involving patient avatar 535can be based in large part on past interactions and presentcircumstances of patient avatar 535. Similarly, present interactionsinvolving physician avatar 445 can be based in large part on thelearning experiences of physician avatar 445 within the medicalsimulation. As such, physician avatar 445 can develop and change as themedical simulation progresses. For example, if a previous meetingbetween patient avatar 535 and physician avatar 445 was friendly andsuccessful, physician avatar 445 may exhibit confidence and friendlinessduring a present meeting with patient avatar 535. Alternatively, presentbehaviors, expressions, and emotions may be based on the sum of theexperiences of physician avatar 445 within the medical simulation. Forexample, if physician avatar 445 has had more unsuccessful interactionsthan successful interactions, physician avatar 445 may exhibitnervousness, fear, and hesitation, regardless of whether the lastinteraction between physician avatar 445 and patient avatar 535 wassuccessful.

FIG. 8 is a diagram illustrating a virtual conference room 800 inaccordance with an exemplary embodiment. Virtual conference room 800 canallow a plurality of users to simultaneously review patient or any of ahost of other information, consult an expert, hold a roundtablediscussion, or otherwise communicate with one another. Virtualconference room 800 includes a couch 805 and a table 810. Virtualconference room 800 can also include chairs, vending machines,decorations, artwork, windows, doors, and/or any other objects commonlyfound in a real-world conference room. Virtual conference room 800 alsoincludes a computer terminal 815 such that users can access informationand/or communicate with other users. A conference phone 820 can be usedby users to receive audio data from patients, experts, professors, orother individuals. A video screen 825 can be used to provide videoand/or textual information to users. Video screen 825 can also be usedto hold video conferences with patients, experts, or any otherindividuals within the simulation.

Virtual conference room 800 includes a first avatar 830, a second avatar835, and a third avatar 840. In an exemplary embodiment, first avatar830, second avatar 835, and third avatar 840 can communicate with oneanother by any of the communication methods described herein. Firstavatar 830, second avatar 835, and third avatar 840 can also communicatewith other individuals through computer terminal 815, conference phone820, video screen 825, and/or any other communication device such as apda, cellular telephone, pager, etc. As an example, first avatar 830 maybe a radiation oncologist for a patient, second avatar 835 may be aprimary doctor of the patient, and third avatar 840 may be a socialworker who is working with the patient. The radiation oncologist, theprimary doctor, and the social worker can discuss the patient with oneanother. The radiation oncologist, primary doctor, and social worker canalso speak with a bioethics expert (not shown) through video screen 825to obtain information regarding treatment of the patient.

Video conference room 800 also includes a data store 845. Data store 845can include a variety of information regarding a medical topic, apatient, a physician, a facility, etc. Data store 845 can include aplurality of tabs such that specific information can be readily accessedand displayed. The information can be displayed on video screen 825 or aseparate data screen (not shown). As an example, first avatar 830,second avatar 835, and third avatar 840 may be discussing a patient, anddata store 845 may include information regarding the patient. A firsttab of data store 845 may include x-rays of the patient, a second tab ofdata store 845 may include the results of laboratory work done on thepatient, a third tab of data store 845 may include billing informationassociated with the patient, a fourth tab of data store 845 may includepersonal information of the patient, a fifth tab of data store 845 mayinclude links to medical resources such as websites and journals, asixth tab of data store 845 may initiate a connection with an expert orother consultant, etc. In an exemplary embodiment, users can select atab of data store 845 to display the information included within thetab. Tabs may be selected by causing the avatar to touch the tab, byentering a command, or by any other method. In alternative embodiments,data store 845 may be constructed as a rotating data wheel, as a table,or as any other type of data structure which is accessible to the users.

The description with reference to FIGS. 4-8 is directed towardinteractions among physicians, patients, and medical staff. However, thetraining system described herein is not limited to medical training. Inan alternative embodiment, the training system may be used to train lawstudents and attorneys how to successfully interact with clients. Insuch an embodiment, the training system dialog and/or scenarios withinthe simulation can be designed by law professors and experiencedattorneys such that young attorneys can gain valuable experience withoutjeopardizing real life client relationships. For example, an attorneyavatar may meet with a client avatar who is accused of first degreehomicide. The attorney avatar can have a goal of convincing the clientavatar that it is best if the client avatar tells the truth. In anotherinteraction, the attorney avatar may meet with a client avatar who isseeking a divorce from her husband. The attorney avatar can have a goalof convincing the client avatar to control her emotions and berespectful towards her spouse while in the courtroom. Countless otherscenarios can be used to teach attorneys how to interact with clients invirtually any area of law. In an alternative embodiment, the interactioncan be a teacher/student interaction, a coach/player interaction, amanager/employee interaction, a dental hygienist/patient interaction, anurse/patient interaction, etc.

One or more flow diagrams have been used to describe exemplaryembodiments. The use of flow diagrams is not meant to be limiting withrespect to the order of operations performed. The foregoing descriptionof exemplary embodiments has been presented for purposes of illustrationand of description. It is not intended to be exhaustive or limiting withrespect to the precise form disclosed, and modifications and variationsare possible in light of the above teachings or may be acquired frompractice of the disclosed embodiments. It is intended that the scope ofthe invention be defined by the claims appended hereto and theirequivalents.

What is claimed is:
 1. A method of assessing one or more characteristicspertinent to interpersonal interactions possessed by an individual, themethod comprising: establishing a simulated environment using at leastone computer; establishing at least one computer-controlled scenarioavatar within the simulated environment using the at least one computer,wherein the at least one computer-controlled scenario avatar has a humanappearance and is programmed to exhibit emotional behavior and cognitivebehavior emulating a human in response to a user's input received via aninput device operably coupled to the computer, wherein the user's inputcomprises a plurality of emotional components and a plurality ofcognitive components, wherein the at least one scenario avatar'sresponse to the user's input comprises a plurality of emotionalcomponents and a plurality of cognitive components, and wherein theinput device includes an audio input device to capture voice input andan imaging input device to capture body language input; presenting auser with at least one scenario within the simulated environment usingthe at least one computer, wherein the at least one scenario includes anemotional and cognitive interaction between the user and the at leastone scenario avatar, and wherein the at least one scenario is selectedbased upon a state of at least one characteristic pertinent tointerpersonal interactions possessed by the user prior to presentationof the at least one scenario; capturing the user's input using the atleast one input device; and using the at least one computer to assessthe at least one characteristic pertinent to interpersonal interactionspossessed by the user using the captured user input.
 2. The methodaccording to claim 1, wherein the step of using the at least onecomputer to assess the at least one characteristic pertinent tointerpersonal interactions possessed by of the user comprises: providingat least one evaluation criterion defining a performance goal; andcomparing the captured user input to the at least one evaluationcriterion to assess whether the user achieved the performance goal. 3.The method according to claim 1, wherein the at least one characteristiccomprises a professional competency of the user.
 4. The method accordingto claim 3, wherein the step of presenting a user with at least onescenario comprises selecting at least one scenario based upon a level ofthe professional competency of the user prior to presentation of the atleast one scenario.
 5. The method according to claim 1, wherein the stepof presenting a user with at least one scenario comprises: presentingthe user with a first scenario based at least in part upon the at leastone characteristic to be assessed prior to presentation of the firstscenario; and presenting the user with a second scenario based at leastin part upon the assessment of the at least one characteristic using thecaptured user input responsive to the first scenario.
 6. The methodaccording to claim 1, wherein the step of presenting a user with atleast one scenario comprises: presenting the user with a series ofscenarios related to the at least one characteristic to be assessed, theseries of scenarios including a first scenario and a plurality offollow-on scenarios, wherein each of the plurality of follow-onscenarios is based at least in part upon the captured user inputresponsive to at least one prior scenario.
 7. The method according toclaim 6, wherein each of the plurality of follow-on scenarios is basedat least in part upon the captured user input responsive to theimmediately prior scenario.
 8. The method according to claim 1, whereinthe plurality of emotional components and the plurality of cognitivecomponents of the user input comprises the user's nonverbal behavior. 9.The method according to claim 1, wherein the plurality of emotionalcomponents and the plurality of cognitive components of the user inputcomprises an element of the user's speech prosody.
 10. The methodaccording to claim 1, wherein the plurality of emotional components andthe plurality of cognitive components of the user's input comprises atleast one voice analysis input captured using at least one audio inputdevice operably coupled to the computer.
 11. The method according toclaim 10, wherein the at least one voice analysis input is selected fromthe group consisting of a user stress level, a user nervousness level,and a user tone of voice.
 12. The method according to claim 1, whereinthe plurality of emotional components and the plurality of cognitivecomponents of the user's input comprises at least one nonverbal input.13. The method according to claim 12, wherein the at least one nonverbalinput comprises a psychometric input.
 14. The method according to claim1, wherein the at least one body language input comprises at least onefacial expression input.
 15. The method according to claim 14, whereinthe at least one facial expression input comprises user eye movement.16. The method according to claim 15, wherein the user eye movementcomprises eye contact.
 17. The method according to claim 1, wherein theplurality of emotional components and the plurality of cognitivecomponents of the user's input comprises a timing of an interactionbetween the user and the at least one computer-controlled scenarioavatar.
 18. The method according to claim 1, wherein the plurality ofemotional components and the plurality of cognitive components of the atleast one computer-controlled scenario avatar's response comprises atone of voice in which the at least one computer-controlled scenarioavatar speaks.
 19. The method according to claim 1, wherein theplurality of emotional components and the plurality of cognitivecomponents of the at least one computer-controlled scenario avatar'sresponse comprises a stress level experienced by the at least onecomputer-controlled scenario avatar expressed in one or more of a toneof voice in which the at least one computer-controlled scenario avatarspeaks and body language exhibited by the at least onecomputer-controlled scenario avatar.
 20. The method according to claim1, wherein the plurality of emotional components and the plurality ofcognitive components of the at least one computer-controlled scenarioavatar's response comprises a nervousness experienced by the at leastone computer-controlled scenario avatar expressed in one or more of atone of voice in which the at least one computer-controlled scenarioavatar speaks and body language exhibited by the at least onecomputer-controlled scenario avatar.
 21. The method according to claim1, wherein the plurality of emotional components and the plurality ofcognitive components of the at least one computer-controlled scenarioavatar's response comprises body language exhibited by the at least onecomputer-controlled scenario avatar.
 22. The method according to claim21, wherein the body language comprises a facial expression exhibited bythe at least one computer-controlled scenario avatar.
 23. The methodaccording to claim 22, wherein the facial expression comprises eyemovement of the at least one computer-controlled scenario avatar. 24.The method according to claim 1, wherein the at least one characteristicpertinent to interpersonal interactions possessed by the user isselected from the group consisting of: values; empathy;client-centeredness; professionalism; interviewing skills; communicationskills; professional skills; and rapport.
 25. The method according toclaim 1, wherein the simulated environment comprises an open worldenvironment.
 26. A system for assessing one or more characteristicspertinent to interpersonal interactions possessed by an individual,comprising: a setting processor configured to establish a simulatedenvironment; a scenario processor configured to present at least onescenario within the simulated environment to a user of the system,wherein the scenario includes emotional and cognitive interactionbetween the user and at least one computer-controlled scenario avatar,wherein the at least one scenario is selected based upon a state of atleast one characteristic pertinent to interpersonal interactionspossessed by the user prior to presentation of the at least onescenario, wherein the at least one scenario avatar has a humanappearance and is programmed to exhibit emotional and cognitive behavioremulating a human in response to user input, wherein the user inputcomprises a plurality of emotional components and a plurality ofcognitive components, and wherein the at least one scenario avatar'sresponse to the user input comprises a plurality of emotional componentsand a plurality of cognitive components; a user input device inoperative communication with the capture processor, wherein the userinput device includes an audio input device to capture a voice input andan imaging input device to capture a body language input; a captureprocessor configured to capture the user input; and an assessmentprocessor configured to assess the at least one characteristic pertinentto interpersonal interactions possessed by the user using the captureduser input.
 27. The system according to claim 26, further comprising agoal processor in operative communication with the assessment processorand configured to generate at least one performance goal for the user,wherein the assessment processor assesses the at least onecharacteristic pertinent to interpersonal interactions possessed by theuser relative to the at least one goal generated by the goal processor.